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Cited by 5Healthcare Decision-Making and RestraintsPersonality Disorders and PsychopathologyPsychopathy, Forensic Psychiatry, Sexual Offending

Coercion, competence, and consent in offenders with personality disorder

Open access
Zlodre, J., Yiend, J., Burns, T., Fazel, S.·2016·Psychology, Crime & Law
DOI 10.1080/1068316x.2015.1109086PMC PMC4896379
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Abstract

Competence to consent to treatment has not previously been examined in a personality disorder cohort without comorbid mental disorder. We examined competence and coercion in 174 individuals diagnosed with severe personality disorder using two validated tools (the MacArthur Competence Assessment Tool for Treatment and the MacArthur Coercion Assessment Scale - Short Form). Competence was not categorically impaired, but there were variations within the sample on dimensional competence measures. Further, there were significant negative correlations between experienced coercion and competence. Higher coercion scores were associated with two components of competence: lower understanding and reasoning. Patients who consented to treatment had higher scores on competence measures and experienced less coercion. These findings suggest that therapeutic approaches that decrease experienced coercion and increase competence may increase the engagement of individuals diagnosed with severe personality disorders in treatment.

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Crossref · 10.1080/1068316x.2015.1109086

Cites

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  • Three studies found that a lack of capacity to consent was associated with higher perceived coercion.

    “Regarding decision-making capacity, three studies found that a lack of capacity to consent was associated with higher perceived coercion [79,101,113].”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [113]

    The Results (Correlations; page unavailable) associate higher perceived coercion with lower scores on the understanding and reasoning components of competence. The paper does not establish that people who lacked capacity to consent—as a categorical finding—perceived more coercion; its Discussion says most participants were competent. This verdict concerns only Zlodre’s study, not the other two citations. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • One study reported that patients who consented to treatment scored higher on competence assessments and experienced lower levels of perceived coercion.

    “Additionally, one study reported that patients who consented to treatment scored higher on competence assessments and experienced lower levels of perceived coercion [113].”

    From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [113]

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Cites

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Research works printed but not linked: 1

  1. Wechsler D Wechsler adult intelligence scale – 3rd edition (WAIS-3®) 1997 San Antonio, TX Harcourt Assessment

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Related

Authors
Zlodre, J., Yiend, J., Burns, T., & Fazel, S.
Affiliations
  • Oxford Health NHS Foundation Trust (GB)
  • King's College London (GB)
  • Warneford Hospital (GB)
Corresponding author
Fazel, S.
ORCID
Venue
Psychology, Crime & Law
Publisher
Informa UK Limited
Published
2015-11-11
Volume
22
Issue
4
Pages
315-330
ISSN
  • 1068-316X (ISSN-L)
  • 1477-2744
DOI
10.1080/1068316x.2015.1109086
PMC
PMC4896379
OpenAlex
W2176570457
Cited by
5
References
45
Citations by year
2025: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2017: 1
FWCI
0.41
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Psychology Crime and Law (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion, cc-by)
  • PubMed Central (acceptedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion, cc-by)
Funders
  • U.S. Department of Justice
  • Wellcome Trust (095806)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
personality disorders, consent to treatment, capacity to consent, offenders, treatment engagement

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